Pikos Symposium 2023
Rehabilitation of the Atrophic Maxilla Using the ZAGA Concept and the New Straumann ZAGA Flat and ZAGA Round Zygomatic Implants
Zygomatic implants have long term documentation as for to be considered a safe and predictable anchorage for prosthetic rehabilitation of the severely atrophic maxilla. The original surgical technique (OST) described by PI Brånemark prescribed an intra-sinus pathway of the implant from a palatal entrance, and the preparation of a “window” antrostomy to control implant path. However, different morphologies of the edentulous maxilla can be identified. The more concave is the maxillary anterior wall, the more marked palatal position of the implant head will be attained if an intra-sinus path is aimed. If the maxilla is very atrophic, the palatal entrance will occur through a thin cortical bone facilitating a subsequent sinus communication. Those situations will frequently end into bulky prosthetic constructions, impaired hygiene and eventual sinus complications.
A protocol to perform a prosthetically driven minimally invasive zygomatic osteotomy, named Zygoma Anatomy-Guided Approach (ZAGA) will be introduced. ZAGA method is aiming at promoting a patient-specific therapy by adapting the osteotomy type to the patient´s anatomy. In most cases, this method avoids the opening of a window or slot into the lateral wall of the maxillary sinus previous to implant placement. Instead, a muco-periosteal flap, including the posterior maxillary wall and the superior zygomatic rim is raised to allow visual control of the complete surgical field. The surgical management of the implant site is guided by the anatomy of the patient according to specific prosthetic, bio-mechanic and anatomic criteria.
The ZAGA Concept represents the logical evolution of the Dr. Aparicio extra-sinus technique and ZAGA classification previously described. Since we may find variations of maxillary anatomy, it is reasonable to count with different types of implant design able to adapt to the patient´s anatomy. In this regard the new zygomatic implant designs Straumann ZAGA Round and Straumann ZAGA Flat, patented by the lecturer will be introduced.
The results of using the combination of the ZAGA Concept together with the new implant designs, consistently show less traumatic osteotomy; better implant stability and bone to implant contact together with better bone sealing around implant neck. Additionally, the rate of late sinus complications dramatically decreases, and more anatomic rehabilitation is achieved
Learning Objectives:
• The clinical scenario of the atrophied maxilla and the possible complications etiology
•The important parameters to consider when performing the zygomatic osteotomy
• How to use the new Straumann ZAGA Round and ZAGA Flat zygomatic implants
• How to evaluate the quality of a report on zygomatic implants
Dr. Carlos Aparicio Biography
Dr. Carlos Aparicio was born in 1953 in Tarazona, Zaragoza. He graduated Summa Cum Laude in Medicine & Surgery in 1978 and completed his Dentistry degree in 1983. He graduated with his Diploma in Implant Dentistry from the University of Gothenburg (P-I Brånemark tutor), Sweden in 1984. In 1990, he graduated with his Master’s Degree in Science of Materials, Polytechnic University of Barcelona in Barcelona, Spain. In 1992, he received a Diploma in Periodontics at the University of Gothenburg (Jan Lindhe tutor) Sweden. In 2010, he completed his Master in Biomedical Research at the University of Barcelona, Ph.D. Summa Cum Laude international mention at the University of Barcelona School of Medicine.
Dr. Aparicio has been a visiting professor for several different universities. He has had the opportunity to be a fellow researcher within the Handicap Research Group in the Department of Biomaterials at the University of Gothenburg in Gothenburg, Sweden. He has been a referee at the European Journal of Oral Implantology and Clinical Implant Dentistry and Related Research. As well as, the Past-President of the Osseointegration Foundation of the American Academy of Osseointegration, a Board member of EAO from 2004-2006, and the Founding President of the Spanish Society of Minimally Invasive Dentistry. In 2016, Dr. Aparicio was a member of the Academic of the Royal European Academy of Doctors.
In 1985, Dr. Carlos Aparicio created the first center dedicated exclusively to the rehabilitation of tooth decay by means of prostheses fixed to the jaw by implants. Today he works to expand the ZAGA philosophy and supports the experts at Zygoma ZAGA Centers dealing with patients with bone atrophy or great bone loss. He has written the book “Zygomatic implants: the Anatomy-Guided Approach” along with numerous doctoral thesis publications based on “Zygomatic implant-based oral rehabilitation. The state of the art and proposed criteria for success.”